Lancashire's special needs services 'transformed' - but some weaknesses remain
The requirements of children with special educational needs and disabilities (SEND) in Lancashire are a “golden thread” running through efforts to deliver the health and care services on which they and their families rely.
That was one of the conclusions of OFSTED inspectors who visited the county to assess its progress after a damning report by the regulator almost three years ago revealed that the needs of young people were not always being met and their parents and carers were left “bewildered” about decisions made on their behalf.
On a return trip to Lancashire shortly before lockdown, OFSTED found a “transformation [which] cannot be underestimated” in the ambition for SEND youngsters in the area.
However, in their report of the visit, published on Wednesday, they also judged that the county had made sufficient progress in only seven out of the 12 “significant weaknesses” identified in 2017 – and that services were still falling short in the remaining five areas.
While stressing that there was still “a huge amount of work to do”, inspectors praised efforts to improve engagement with parents and carers, who were previously described as having lost trust in social care and NHS organisations charged with supporting their children. Having had feedback from 550 families as part of their latest visit, the inspection team found that families now felt “valued and equal partners”.
Improvements were acknowledged in the quality of education, health and care plans (EHCP), which help determine the level of support required by individual children – and parental understanding of that process. Exclusions of SEND children from school were found to now be few and far between.
However, several areas of concern were also highlighted – including difficulty in acquiring basic provisions such as continence products. The county came in for criticism that the situation was still persisting two and a half years after the last OFSTED visit.
Inspectors also found that there was “inequitable” nursing provision in special schools in different areas.
Meanwhile, although autism diagnostic services were found to have improved in both their coverage and consistency, waiting times for assessments were deemed to be too long.
Lancashire County Council’s cabinet member for children, young people and schools, Phillippa Williamson, said that she was pleased with the progress that had been identified by inspectors.
“To have made sufficient improvement in seven out of 12 areas is a major step forward and I’m particularly pleased that OFSTED acknowledged our engagement with parents and carers – and that the families themselves recognised that in their own feedback.
“Ultimately, we are trying to make things right for those families – and if they are saying there has been an improvement, that’s an endorsement.
“We’re a long way from being where we ideally want to be and we recognise the issues raised in the report – they were always going to be picked up, because it’s what was happening on the ground and parents and carers would quite rightly talk about these things – so we need to sort them out.
“OFSTED sets high standards and we were meeting them in seven areas and getting close in some of the others – so we should take comfort from that, but obviously not be complacent,” County Cllr Williamson said.
She added that the “complexity” of the health and care system operating in Lancashire – which involves six different clinical commissioning groups (CCGs) working with the county council to deliver health and care services for SEND youngsters – was always going to be challenging.
An action plan to tackle outstanding weaknesses identified by OFSTED is expected to be drawn up in the coming weeks.
The Local Democracy Reporting Service also understands that the county’s health and wellbeing board – whose membership is derived from a range of public and voluntary sector organisations – is going to be asked to set up a sub-committee charged solely with scrutinising SEND issues. If the proposal is accepted, the group will monitor attempts to improve the five remaining areas of weakness and attempt to ensure the improvements already achieved are maintained.
WHAT DO PARENTS AND CARERS THINK?
The last time Lancashire’s SEND services were assessed by OFTSED, the county’s parent carer forum (PCF) – designed to give a voice to families with children with special needs – had disbanded.
Since reforming almost two years ago, it has attempted to give families a platform to tell health and care leaders what life is really like for SEND youngsters.
PCF chair Sam Jones said she hoped that parents and carers would recognise the improvements described in the OFSTED report as reflecting their own experience.
“When OFSTED came last time, Lancashire was shocked by the findings – but the parents weren’t. They could have written that report, because they had experienced exactly what the inspectors saw.
“Hopefully, this time, those parents are seeing that things have changed. Obviously, things take a little time to filter down and there are a minority of parents who have genuine issues that they feel have not been addressed.
“None of us are under any illusions, we all know we have still got a significant amount of work to do.
“But the positive working relationships we all have are a shining light. Previously, health did what they did, education did what they did and parents were left trying to get themselves heard. But now we are able to sit down together and have difficult conversations to inform senior people what our lived experience is like – and they have taken that on board as a useful perspective rather than hearing it as a complaint,“ Ms. Jones added.
OFSTED inspectors acknowledged the contribution of the PCF, but noted that its reach among families is “limited”. It is understood that work is underway to engage with more parents and carers.
This is OFSTED’s assessment of the progress made on the 12 “significant weaknesses” it identified during its visit back in November 2017.
Sufficient progress was found to have been made in:
“Plans and strategies reflect the area’s ambitious vision for children and young people with SEND. While there is still a huge amount to do, the transformation across the area cannot be underestimated.”
ENGAGEMENT WITH PARENTS AND CARERS
“At the time of the  inspection, parents’ views and experiences…were ‘overwhelmingly damning’. Parents had lost trust and felt that there was no transparency. Three quarters of the 1,700 parents who completed [a survey] last year rated the levels of support and help that their child received as good or better. A minority of parents continue to feel that their longstanding concerns have not been addressed.”
“Professionals are now much clearer about the point at which [education, health and care] assessments can be requested. When an assessment is turned down, parents and professionals are informed about the reasons for the decision.”
QUALITY OF EDUCATION, HEALTH AND CARE PLANS
“Professionals better understand how to work with children, young people and their parents to gather their views. Plans now accurately reflect children and young people’s needs. Some children still have poor-quality plans [from previously] These will be reviewed within the next year to ensure that their needs are better met.”
“More of the youngest children with SEND are achieving a good level of development than previously. By the end of key stage 1, more children with SEND are meeting the expected standard in reading, writing and mathematics. At the end of key stage 2, there has been a decline overall. [Targeted] work has recently been extended so that more children with SEND across Lancashire benefit from additional support.”
At the initial inspection, the number of exclusions was at an unacceptable level and rising. This is no longer the case – permanent exclusions for children with SEND are now few and far between.”
INEQUALITIES BASED IN LOCATION
“There is now a more equitable service provided by specialist health services across the county. There are more opportunities for families to access services locally. This has reduced some of the pressure on families who were previously travelling long distances for appointments.”
Insufficient progress was found to have been made in:
AUTISM DIAGNOSTIC PATHWAY
"There are now diagnostic pathways for autism spectrum disorder in place across the county, including in the north of the area. However, long waiting times in some areas are limiting the effectiveness of these pathways. Six professionals co-produced the pathway in the north with children, young people and parents. This approach means that this service reflects their needs. However, the partnership underestimated the demand for this service. The service has been swamped by four times the anticipated number of referrals and, as a result, children and young people are waiting too long for an initial appointment.”
County Cllr Williamson said: “We have done everything in a textbook way, but as a result, it has created demand. We are getting the resources in to the system now and it’s starting to ease. In some ways, this a reflection of parents and carers becoming aware that the service is available and they are quite rightly saying that they would like their children to benefit from it.”
"There has been limited progress in resolving the weaknesses found at the initial inspection. Although there has been some activity, this has been piecemeal. For example, there are well-developed plans to extend the delivery of the existing child and adolescent mental health service (CAMHS) to young people up to 19 years old. The early years strategy sets out how young children, including those not in schools or settings, will be supported to be school ready. However, there are still not enough commissioned services for young people up to the age of 25. There is limited effective joint working between children’s and adults’ services. This results in poor experiences for young people.”
County Cllr Williamson said: “Any transition in a young person’s life is particularly difficult when they have got extra needs and need extra support – and we need to work really hard to ensure that it becomes seamless. There are elements of that happening, but in some cases, it’s just not as good as it ought to be.”
LACK OF UNDERSTANDING OF AREA
“There was and still is no system in place to collect the views of parents and carers at the point of service delivery. This means that leaders and managers do not find out how well new systems and services are working quickly enough. Consequently, leaders do not always know whether their actions have made the positive difference for children, young people and their families that was intended."
WEAK JOINT COMMISSIONING
“A well-established group of commissioners from across the partnership work well together now. They have made sure that they are better informed about children and young people’s needs. Effective co-production is helping commissioners to decide what services they need to provide and where they need to provide them. At the initial inspection, inspectors found weaknesses in the services for consumables, such as continence products. Twenty-eight months later, families still struggle to get these consumables. Furthermore, there remains inequitable special school nursing provision and gaps in specialist children’s nursing services.”
POOR LOCAL OFFER
"Leaders have engaged well with parents, children and young people and other partners to redesign the local offer [outlining the support available to SEND families]. Unfortunately, there have been delays in its delivery. This means that the new offer was only launched in January. Furthermore, this work is not yet complete. Parents do not find the information it provides useful. Leaders have a plan to add a directory of services to the local offer and also appoint an officer to keep the information up to date and relevant.”